Cath: Hybrid Procedure - Aortic stent placement for recoarctation after Norwood Procedure

1. Hybrid aortic reconstruction for treatment of recurrent aortic obstruction after stage 1 single ventricle palliation. Medium-term outcomes and results of redilataion.

1. Shelby Kutty MD¹,
2. Redmond P. Burke MD²,
3. Robert L. Hannan MD²,
4. Evan M. Zahn MD, FSCAI^2,*

Catheterization and Cardiovascular Interventions

Volume 78, Issue 1, pages 93–100, 1 July 2011

Catheterization and Cardiovascular Interventions

Volume 78, Issue 1, pages 93–100, 1 July 2011

Abstract

Objective:

We describe a hybrid approach to the treatment of aortic obstruction after stage 1 palliation (S1P) of hypoplastic left heart syndrome.

Background:

Recurrent aortic obstruction is a common problem after S1P of hypoplastic left heart syndrome. Even mild aortic obstruction is poorly tolerated so early and definitive therapy is desirable. Although stent implantation is an effective treatment for aortic obstruction in older children and adults, technical issues due to small vessels and concerns regarding future potential for expansion have generally precluded the use of stents in this setting.

Methods:

Six patients underwent hybrid aortic reconstruction (HAR) in the operating room or catheterization laboratory, with the interventional cardiologist and cardiac surgeon working in cooperation.

Results:

Patients had a mean weight of 5.8 kg (2.9–7.7) and a mean age of 5.6 months (0.5–12.9) at the time of HAR. Five patients had undergone prior balloon angioplasty at a mean age of 2.8 months (2.1–3.5), and five had moderately depressed single ventricular function prior to HAR. The balloons used had a diameter of 7–10 mm and introducer sheath size ranged from 6 to 10 F. There were no immediate or late procedure related complications. Stent redilation was performed in 5 patients for relief of recurrent obstruction or to keep pace with somatic growth. At a median follow up of 4.8 years (0.2–7.9), there were 3 patients progressing well after Fontan palliation and 3 deaths.

Conclusions:

HAR allows for placement of stents that can ultimately reach adult size in small infants who have recurrent aortic obstruction after balloon angioplasty following S1P. Advantages include freedom from delivery sheath constraints when determining stent type/size, facilitation of precise stent position, and avoidance of vascular damage or hemodynamic compromise during the procedure. Longer follow-up and larger experience are required to determine if this therapy will provide a long-term solution to this difficult problem. © 2011 Wiley-Liss, Inc

Hybrid Procedure: Intraop. VSD closure

Catheterization and Cardiovascular Interventions 2011;77:557-563

A novel method of hybrid intraoperative catheter-based closure of ventricular septal defects using the Amplatzer® PDA occluder†
Christian Neukamm MD, et al.

Oslo, Norway & Kiel, Germany

Background: In five patients, an apical muscular septal defect was closed in a hybrid approach using the Amplatzer® duct occluder during open heart surgery, whereas concomitant defects were treated surgically. In addition to their different heart defects that needed surgery, all had a muscular ventricular septal defect in the apex of the heart, poorly accessible for traditional, surgical approach. We describe the method and outcome in these patients.

Methods: The tip of a forceps was advanced from the left into the right ventricle through the ventricular septal defect. The delivery sheath was caught under visual control in the right ventricle and pulled back into the left ventricle. The disc was developed and pulled back until it was felt tugging at the septum. Then the core was developed. The end of the device was visible in the right ventricle and was secured with a Prolene® suture.

Results: The procedures were event-free. During early follow-up there were either no or only insignificant shunts in the region of the prior trabecular defects in four patients. The unsatisfactory result in the last patient was caused by inaccurate preoperative assessment.

Conclusion: The method seems valuable in patients in need of other intracardiac surgery.

© 2010 Wiley-Liss, Inc.